Holding the principle of "aegroti salus lex suprema"

Photo by Luthfiah VOI

JAKARTA - Many people think that being a medical school graduate will have a stable and prosperous life. Have high salaries, luxury cars, big houses, and a bright future. In Indonesia, the profession of a doctor is a profession that parents dream of for their children even prospective spouses.

In fact, to achieve the dream of becoming a doctor, one must dig into a not insignificant pocket. The cost of medical education, which includes the pre-clinical education phase or S1 medicine and the clinical education phase, also known as the doctor's profession, is getting more and more inflated.

The cost of medical education varies greatly between state universities and other state universities. In addition to the difference in the range of medical costs at private universities. State universities use a tuition payment system called a single tuition or UKT and private universities use a tuition payment system that is 'not single', including payment of building money, book money, and so on. The average cost of medical education costs 25-50 million each semester.

Not to mention when looking at the journey to become a doctor which is not easy. In general, becoming a doctor takes a relatively long time compared to education at other strata levels. In terms of time, education to become a doctor in Indonesia takes about 6.5 years (the fastest) with the following details: 3.5 years of medical undergraduate education, 2 years of following koas and 1.5 years of following intership plus the queue.

The above facts are highlighted by the Biomolecular Expert of Sriwijaya University (Unsri), Prof. Yuwono. According to him, the very expensive cost of medical education is feared to make medical faculty graduates work with the intention of returning the investment in education. This means that future doctors have an orientation to work to find money only. It is no longer based on the interest to save the community, but to generate money.

"If this is true, of course this deviates from the obligation of doctors to patients who must be sincere and use all their knowledge and skills for the benefit of patients," he said.

He assessed that work as a doctor can only be obtained by people who have money. Because, the cost that parents have to spend is very large. He mentioned that the Education Operational Cost (BOP) can reach around Rp. 200 million when entering. Then, the preclinical cost ranges from Rp. 30 million per semester and the clinic cost of Rp. 45 million per semester.

"Relatively only rich people can afford to study medicine. Investing in educating a person to become a doctor is not cheap. I am afraid, after becoming a doctor, they will compete to find money to return the investment of almost 750 million (12 semesters)," he continued.

Therefore, Yuwono hopes that the government can provide cost relief for young Indonesians who aspire to be doctors. So that there is no wasted young talent. "Hopefully the government can finance this 50 percent-100 percent, so that smart, talented, but poor children can become doctors who are moral, smart and love to help," he said.

The burden of expensive medical tuition, perhaps the most expensive among other study interests at various Indonesian campuses, has resulted in many of its graduates - although not all - thinking they have to pay back their capital and practice health businesses. Such as selling medicine, or suggesting major medical actions such as cesarean section surgery even though the patient is able to give birth normally.

The "individual" doctors turned out to be sales agents and managed to receive commissions. He made patients lose money because they had to spend extra money and undergo wasteful medical procedures. A relatively new practice, doctors fill out a question-and-answer column on a health consultation application, which is a new means of approaching medical services in the current era.

Humanity and the Principle of Ceteris Paribus in the World of Medicine

Assistant Researcher of the Center for Health Policy and Management, UGM, dr. Ariana Maharani explained, if the cost of medical education is translated as a high price, according to the law of demand and supply, in accordance with the sound of the law of demand: "If the price of a commodity increases, then the amount of goods requested will decrease. Conversely, if the price of a commodity decreases, then the amount of goods that will be requested will increase (Ceteris Paribus)".

With the high "price" of medical school, it should not make the demand for medicine higher. However, every year the data shows that medicine continues to excel at the top rankings as the most popular study program both in the National Selection for State Universities (SNMPTN) and the Joint Selection for State Universities (SBMPTN).

If medical school is likened to an investment, where one of the factors that affects investment in economics is the expected rate of return. "The next question is, is the expected rate of return by going to medical school a promising rate," he said.

Regarding the discussion related to the rate of return, Ariana revealed that the salary earned by a doctor, both general practitioners and specialists, varies greatly. Doctors who work in clinics will have different salaries from those who work in independent doctor practices, and will also be different from those who work in health centers, and also different from those who work in hospitals.

"The work status will also affect it. Whether it's an intern, a non-permanent employee (PTT) or a civil servant. However, it is not important regarding these variations, because it may be that the workload in each place is different so it is not fair if the salary of doctors is compared in all places. But the important point that needs to be emphasized is the minimum salary that a doctor can earn," he said.

He said, in fact, the Indonesian Doctors Association (IDI) had made a recommendation for the minimum salary for general practitioners. The minimum is around IDR 12.5 million per month. However, in the field, not a few general practitioners receive salaries of less than IDR 3 million per month.

"With salaries that do not reach the minimum limit recommended by professional organizations and even some who do not touch the regional minimum wage limit and this really happens, with expensive school fees but joking salaries, can medical school be rationalized by the law of demand or the law of investment in economics," said Ariana.

"The cost of medical school makes me understand the meaning of the word Ceteris Paribus in the law of demand or supply. Ceteris Paribus comes from Latin and means with all other things equal or when all other conditions are equal," he continued.

When someone says ceteris paribus, it is assumed that all other variables are considered constant. It could be that the increasing cost of medical college, but it is not followed by a decrease in interest in medical college alias more and more interest every year is because other variables are not constant.

The next question is, what is the variable? The variable is the variable of public confidence that when someone decides to become a doctor and agrees on the number of medical college fees, a doctor's orientation is not only a money orientation.

"Being a doctor means deciding to live humanistically. Therefore, the analysis of the return of capital is the most irrelevant analysis in the world of medicine, given that medicine has successfully fought against the law of demand," said Ariana.

He emphasized that in carrying out the role as a doctor, the principle of "aegroti salus lex suprema" must be held firmly, which means that patient safety is the highest priority and highest responsibility in relation to the most valuable thing in the world, namely "human life". Therefore, a doctor must be ready to take professional responsibility for every action he takes.

"That's why the government should pay attention to the welfare of doctors. Doctors are also human beings, which are economic creatures. Humans are called economic creatures because humans always think about efforts to meet their needs in accordance with economic principles. The government must act responsive to issues of doctor welfare so that the principle of the rate of return or capital return can be lost," concluded Ariana.